Alzheimer’s Disease and other dementias

Over four million Americans have one form of dementia: Alzheimer’s disease. As the population of the United States ages and the life expectancy increases, this number is expected to rise to 14 million by the year 2030. It is most prevalent in the oldest members of our population; those over age 85 where nearly 30 percent suffer with the disease. Often, the question comes “Doesn’t everyone lose their memory as they get older?” True, there are some changes that occur as a result of aging, including slower processing of new information and slower recall; however, these lapses of memory of natural aging are not disabling.

Dementia and
Alzheimer’s disease
Dementia is not just one disease but rather describes the memory loss and other cognitive changes associated with several different diseases. First described by Dr. Alois Alzheimer in 1906, Alzheimer’s disease is the most common form, accounting for 40 percent of all diagnosed dementias by itself and over 70 percent when combined with vascular dementia, the second most common type. Vascular dementia is related to large or small strokes and goes also by the term multi-infarct dementia. A number of other diseases can have dementia as a late feature including Parkinson’s disease, AIDS, Down’s Syndrome and repeated head trauma, such as concussions.

Diagnosing Dementia
Because dementia often progresses slowly, early detection may be difficult. However, the combination of short term memory loss and the inability of the person to complete usual tasks should prompt investigation. There is no blood test that can diagnose dementia. A healthcare provider will often ask a series of questions to assess orientation (awareness of surroundings), memory, attention to detail, visual and writing processing and thinking. The most common test is the Mini Mental State Exam (MMSE). More elaborate testing is available through a geriatric specialist, neurologist or neuropsychologist. While dementia is a brain disorder, xrays of the brain, CT scan or MRI, may suggest but cannot directly diagnose the disease. Further evaluation includes tests to rule out problems other than dementia that are causing memory complaints.

Staging the Disease
There are at least three stages of Alzheimer’s disease, The Mild Stage, The Moderate Stage and The Severe Stage. Each person moves through them at different rates and may not exhibit all the changes possible in any one stage.

Treatment of Alzheimer’s dementia
Alzheimer’s disease and the other dementias are not curable. However, there are many medications available to help slow the progression. They have been best studied in Alzheimer’s disease but have been found to have some effect in vascular dementia and the dementia associated with Parkinson’s disease. The principles of treatment rely on the thought that it is caused by a deficiency (or lack) of a brain protein called acetylcholine. The three major medications used to treat dementia (donepezil, galantamine, rivastigmine; sold under the brand names Aricept, Razadyne and Exelon respectively) all keep this protein from being destroyed. They have each been proven to slow the progression of the disease. A newer medicine, memantine (sold under the brand name Namenda) works by a different mechanism and is approved to treat more advanced stages of the disease.

Can dementia
be prevented?
Risk factors for Alzheimer’s disease include advancing age, female gender, and lower education level. Those with vascular problems, including hypertension, diabetes, and high cholesterol are also at higher risk. Controlling these three vascular problems can decrease the risk. Exercising, eating healthy and taking vitamins like B12, folate and vitamin E may decrease frequency of the disease.

There are many support groups to assist that should be accessed. The Alzheimer’s Association has local chapters that provide support groups and is a valuable resource for community services. They can be reached at 1-800-272-3900 or www.alz.org.

For more information about the Maya Angelou Center for Health Equity and additional resources, visit our website http://www.wakehealth.edu/MACHE or call toll-free 877-530-1824.